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BackgroundThe Eastern Mediterranean Region (EMR) faces numerous public health risks caused by biological, chemical, man-made, and natural hazards. This manuscript aimed to assess the multifaceted interventions and strategies used to strengthen the EMR’s preparedness capacities to respond properly to current and upcoming health emergencies.ObjectiveTo address these challenges, it is crucial to implement comprehensive and robust strategic risk assessments and health emergency preparedness frameworks. The World Health Organization (WHO) takes a risk-based approach, emphasizing the significance of all-hazards emergency management and the creation of national health risk profiles using the Strategic Toolkit for Assessing Risk (STAR). Furthermore, the International Health Regulations (IHR) Monitoring and Evaluation Framework (MEF) ensures continuous learning and capacity building among Member States, enhancing their ability to manage health emergencies effectively. Key components include State Party Annual Reporting (SPAR), Joint External Evaluation (JEE), After Action Review (AAR), Intra Action Review (IAR), and Simulation Exercises (SimEx). Moreover, initiatives like One Health, Emergency Care Systems, Safe Hospitals, and Public Health Emergency Operations Centers (PHEOCs) reinforce preparedness and response capacities. Risk communication and community engagement (RCCE) strategies play a pivotal role in disseminating timely information and fostering community resilience. Furthermore, the management of Chemical, Biological, and Radiological (CBRN) incidents remains a priority, necessitating collaboration between the public health and security sectors. This comprehensive approach aims to strengthen health systems, reduce risks, and improve emergency response capabilities throughout the EMR, thereby promoting global health security and resilience.ConclusionThe EMR is addressing public health challenges through frameworks like IHR-MEF, and RCCE. It is strengthening emergency care systems, ensuring safe hospitals, and establishing PHEOCs. Proactive measures to address CBRN events and collaboration are enhancing resilience. The inclusion of the One Health approach underscores the EMR’s holistic strategy to address the health threats at the human-animal-environment interface. This demonstrates the EMR’s commitment to global health security.

Introduction: Several scoring systems were developed for early risk stratification in Upper Gastrointestinal Bleeding (UGIB) patients. AIMS65 score is a scoring system that only consists of five parameters, it might be used in daily clinical practice because of rapid and easy to calculate within 12 hours of admission. Objective: To evaluate the AIMS65 scoring system as a predictor of mortality, rebleeding events, need for endoscopic therapy, blood transfusion, and ICU admission for all causes of UGIB. Methods: We conducted a systematic review on PubMed, ScienceDirect, ProQuest, and Cochrane Library databases from the 2012 to 2022 publication period. We included either prospective or retrospective cohort studies that reported UGIB with all kinds of aetiologies who presented in the emergency department (ED), reported discriminative performance for each outcome, and reported the optimal cut-off of AIMS65. The primary measurement of discriminative performance for clinical outcomes includes mortality, rebleeding incidents, need for endoscopic therapy, blood transfusion, and ICU admission. Results: We identified 351 published studies, of which 20 were included in this study. Most of the studies reported discriminative performance for predicting mortality, which amounts to about 18 out of 20 studies. Rebleeding prediction was reported in 11 studies, need for endoscopic therapy in 5 studies, blood transfusion in 7 studies, and ICU admission in 2 studies. Most of the studies reported fair to excellent discriminative performance for predicting mortality, but in contrast for predicting rebleeding, the need for endoscopic therapy, blood transfusion, and ICU admission. Cut-off values≥ 2 are frequently reported to distinguish between high-risk and low-risk patients in mortality. Conclusion: AIMS65 can be applied to patients with UGIB in ED for predicting mortality, but not applicable for predicting rebleeding events, the need for endoscopic therapy, blood transfusion, and ICU admission. It enhances early decision-making and triage for UGIB patients.

Introduction: Team-based patient management in critical care demands a knowledgeable, skillful, and responsive doctor who collaborates well on teams. Medical education is responsible for producing competent graduates who meet the above requirements. However, the current medical curriculum in Indonesia tends to focus only on individual knowledge and appraisal. There was no standardized university-based group emergency training and examination with comprehensive emergency topics beyond cardiac and trauma cases. Objective: This study aimed to develop and evaluate a team-based emergency training program that enhances medical students' preparedness and teamwork skills in dealing with future emergencies in the workplace. Materials and Methods: We developed Acute Life Threatening Events Management (ALTEM), a three-day emergency training program consisting of pre-test, lectures, guided skill practice, group (case-based) simulation exam, and post-test. Group simulation occurred in a virtual hospital with high-fidelity mannequins, actual medical equipment (i.e., beds, monitors, drugs, tools, pads), two-way mirror rooms, and simulated patient family to resemble real hospital situations. The program was then evaluated by a modified Kirkpatrick evaluation model, which measures individual perception, satisfaction, understanding, and performance related to the program. Results: A total of 114 participants were involved in this study. Most subjects (>80%) had a good experience with the program. ALTEM training program significantly increased communication and teamwork (p

Abstract Background The failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing. Methods/Results The article outlines eight challenges associated with global health financing instruments and development aid for health within the global health literature. These include misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Using available information about the Pandemic Fund, the article positions the Pandemic Fund against these challenges to determine in what ways the financing instrument recognizes, addresses, partially addresses, or ignores them. The assessment argues that although the Pandemic Fund has adopted a few measures to recognise and address some of the challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed. Conclusion It remains unclear how the Pandemic Fund is explicitly addressing challenges widely recognized in the global health financing literature. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers four sets of policy recommendations for how the Pandemic Fund and the PPR financing architecture might respond more effectively to the identified challenges.

Background: The failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing. Methods/Results: The article outlines eight challenges associated with global health financing instruments and development aid for health within the global health literature. These include misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Using available information about the Pandemic Fund, the article positions the Pandemic Fund against these challenges to determine in what ways the financing instrument recognizes, addresses, partially addresses, or ignores them. The assessment argues that although the Pandemic Fund has adopted a few measures to recognise and address some of the challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed. Conclusion: It remains unclear how the Pandemic Fund is explicitly addressing challenges widely recognized in the global health financing literature. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers four sets of policy recommendations for how the Pandemic Fund and the PPR financing architecture might respond more effectively to the identified challenges. [ABSTRACT FROM AUTHOR]

Background: The second wave of COVID-19 severely affected the healthcare workforce, including doctors, nurses, public servants, and medical students, even though the system was better prepared than the first wave. Objectives: To assess the preparedness and preventive measures of the health science students towards the second wave of COVID-19. Methodology: The study has been carried out in Kasturba Medical College (KMC) and Manipal College of Dental Sciences (MCODS), Mangalore, after getting approval from the institutional ethics committee (IEC) and concerned deans of institutions. The responses to the questionnaires have been taken in for analysis which constitutes three parts. The chi-square test was applied to compare the variables between medical and other health sciences students considering the significant P value less than 0.05. Results: The overall readiness regarding the surge in COVID-19 cases in India among our study participants was 99.3% which was highest among AHS students. Many of the students in the study showed passion and were prepared to assist health professionals at Health and Triage centres, with the highest distribution in AHS (97.2%), BDS (87%), and MBBS (85.8%). They believed that adequate protective gear and infection testing were needed for an effective return to the clinical setting. Conclusion: Ultimately, the health science student population in the study settings possesses sufficient resources and knowledge to combat the second wave of COVID-19. However, a certain shortcoming remains in the form of laxity toward preventive measures and social exclusion.

Background: The Eastern Mediterranean Region (EMR) faces numerous public health risks caused by biological, chemical, man-made, and natural hazards. This manuscript aimed to assess the multifaceted interventions and strategies used to strengthen the EMR's preparedness capacities to respond properly to current and upcoming health emergencies., Objective: To address these challenges, it is crucial to implement comprehensive and robust strategic risk assessments and health emergency preparedness frameworks. The World Health Organization (WHO) takes a risk-based approach, emphasizing the significance of all-hazards emergency management and the creation of national health risk profiles using the Strategic Toolkit for Assessing Risk (STAR). Furthermore, the International Health Regulations (IHR) Monitoring and Evaluation Framework (MEF) ensures continuous learning and capacity building among Member States, enhancing their ability to manage health emergencies effectively. Key components include State Party Annual Reporting (SPAR), Joint External Evaluation (JEE), After Action Review (AAR), Intra Action Review (IAR), and Simulation Exercises (SimEx). Moreover, initiatives like One Health, Emergency Care Systems, Safe Hospitals, and Public Health Emergency Operations Centers (PHEOCs) reinforce preparedness and response capacities. Risk communication and community engagement (RCCE) strategies play a pivotal role in disseminating timely information and fostering community resilience. Furthermore, the management of Chemical, Biological, and Radiological (CBRN) incidents remains a priority, necessitating collaboration between the public health and security sectors. This comprehensive approach aims to strengthen health systems, reduce risks, and improve emergency response capabilities throughout the EMR, thereby promoting global health security and resilience., Conclusion: The EMR is addressing public health challenges through frameworks like IHR-MEF, and RCCE. It is strengthening emergency care systems, ensuring safe hospitals, and establishing PHEOCs. Proactive measures to address CBRN events and collaboration are enhancing resilience. The inclusion of the One Health approach underscores the EMR's holistic strategy to address the health threats at the human-animal-environment interface. This demonstrates the EMR's commitment to global health security., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elhakim, Hammoud, Gmach, Albadri, Mahrous, Arifi, Abdel Latif, Moussa, Anan, Saidouni, Ghazy, Elkholy, Elsakka and Samhouri.)

Strong, trusted partnerships within a social capital framework are core to Peace Corps’ successful international, national, and community interactions and outcomes. The Peace Corps’ integrated three level model has thrived since its beginning in 1961. During this time, about 250 000 two-year Volunteers have lived and worked in 142 countries. In March 2020, the Peace Corps had to evacuate all 7 000 currently serving Volunteers because of the world-wide Covid-19 pandemic, a task organized and completed in nine days. The evacuation’s success depended on the resiliency of these honored long-term partnerships, and specifically: a partnership model with three intertwining layers of collaboration between national and host country staff and Volunteers; years of respectful integration of Volunteers in local communities building mutual trust; in-country and cross-nation preparedness for health, safety, and security emergencies; transparent communication during the evacuation among all involved parties in every nation with Volunteers; and in-country and host country staff support across countries during the evacuation. This case study illustrates elements of effective and sustainable partnerships that ensure their effectiveness during a crisis and survival beyond the crisis. I write this at the anniversary of one year from my stepping down as the twentieth Director of the Peace Corps. During my tenure, I brought home all 7 000 currently serving Volunteers in nine days as the Covid-19 pandemic spread across countries. This massive – and successful – undertaking was possible because of long-standing and trusted partnerships between the Peace Corps and the communities and countries hosting Peace Corps Volunteers. This is my personal reflection and a reminder to build, honor, and tend relationships with international partners who are collaborators in learning, service, and research in good times and our friends, protectors, and allies in times of crisis.

The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (NCDs). In addition to older age, people living with CVD, stroke, obesity, diabetes, kidney disease, and hypertension are at a particularly greater risk for severe forms of COVID-19 and its consequences. Meta-analysis indicates that hypertension, diabetes, chronic kidney disease, and thrombotic complications have been observed as both the most prevalent and most dangerous co-morbidities in COVID-19 patients. And despite the nearly incalculable physical, mental, emotional, and economic toll of this pandemic, forthcoming public health figures continue to place cardiovascular disease as the number one cause of death across the globe in the year 2020. The world simply cannot wait for the next pandemic to invest in NCDs. Social determinants of health cannot be addressed only through the healthcare system, but a more holistic multisectoral approach with at its basis the Sustainable Development Goals (SDGs) is needed to truly address social and economic inequalities and build more resilient systems. Yet there is reason for hope: the 2019 UN Political Declaration on UHC provides a strong framework for building more resilient health systems, with explicit calls for investment in NCDs and references to fiscal policies that put such investment firmly within reach. By further cementing the importance of addressing circulatory health in a future Framework Convention on Emergency Preparedness, WHO Member States can take concrete steps towards a pandemic-free future. As the chief representatives of the global circulatory health community and patients, the Global Coalition for Circulatory Health calls for increased support for the healthcare workforce, global vaccine equity, embracing new models of care and digital health solutions, as well as fiscal policies on unhealthy commodities to support these investments.

The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (NCDs). In addition to older age, people living with CVD, stroke, obesity, diabetes, kidney disease, and hypertension are at a particularly greater risk for severe forms of COVID-19 and its consequences. Meta-analysis indicates that hypertension, diabetes, chronic kidney disease, and thrombotic complications have been observed as both the most prevalent and most dangerous co-morbidities in COVID-19 patients. And despite the nearly incalculable physical, mental, emotional, and economic toll of this pandemic, forthcoming public health figures continue to place cardiovascular disease as the number one cause of death across the globe in the year 2020. The world simply cannot wait for the next pandemic to invest in NCDs. Social determinants of health cannot be.addressed only through the healthcare system, but a more holistic multisectoral approach with at its basis the Sustainable Development Goals (SDGs) is needed to truly address social and economic inequalities and build more resilient systems. Yet there is reason for hope: the 2019 UN Political Declaration on UHC provides a strong framework for building more resilient health systems, with explicit calls for investment in NCDs and references to fiscal policies that put such investment firmly within reach. By further cementing the importance of addressing circulatory health in a future Framework Convention on Emergency Preparedness, WHO Member States can take concrete steps towards a pandemic-free future. As the chief representatives of the global circulatory health community and patients, the Global Coalition for Circulatory Health calls for increased support for the healthcare workforce, global vaccine equity, embracing new models of care and digital health solutions, as well as fiscal policies on unhealthy commodities to support these investments. [ABSTRACT FROM AUTHOR]

Background: Community health worker (CHW) programmes are increasingly being recognized as an important strategy that can help to strengthen comprehensive primary health care (PHC), as the foundation of work towards achieving universal health care (UHC) and meeting the Sustainable Development Goals (SDGs). The WHO Regional Office for the Eastern Mediterranean undertook a situational analysis of CHW programmes in the Region to better understand the current situation and the issues involved., Methods: A two-step process was employed: a review of available literature on CHWs in the Region was conducted, followed by a survey of CHW programmes in the region, focussing on programmes that were country-led and country-wide., Results: Thirteen countries were found to have community health worker programmes with varying governance and programmatic structures. Broadly, two categories can be distinguished: (a) several countries have well established and mature national CHW programmes that are in most cases supported by external donors but driven and coordinated by national governments; (b) a greater number of countries that have smaller, emerging government or partner led projects and programmes. A few countries have deliberately opted for other models to strengthen primary care and community outreach, for example, through community nursing., Conclusion: CHW programmes play an increasingly important role in primary health care in the Eastern Mediterranean Region, providing promotive, preventive, and emergency services. This bodes well for efforts to strengthen and embed comprehensive primary health care as the foundation of national health systems, to improve health emergency preparedness, achieve UHC and meet the SDGs. Nonetheless, all but a few programmes face challenges of weak governance, fragmentation and unreliable support, similar to those in other countries. However, the main finding of the analysis was that the role of CHWs in countries' health service delivery is woefully under-researched in almost all countries in the region, and more research to better understand and support programmes in the context of local health system contexts is urgently needed., (© 2024 World Health Organization; licensed by John Wiley & Sons Ltd. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Strong, trusted partnerships within a social capital framework are core to Peace Corps' successful international, national, and community interactions and outcomes. The Peace Corps' integrated three level model has thrived since its beginning in 1961. During this time, about 250 000 two-year Volunteers have lived and worked in 142 countries. In March 2020, the Peace Corps had to evacuate all 7 000 currently serving Volunteers because of the world-wide Covid-19 pandemic, a task organized and completed in nine days. The evacuation's success depended on the resiliency of these honored long-term partnerships, and specifically: a partnership model with three intertwining layers of collaboration between national and host country staff and Volunteers;years of respectful integration of Volunteers in local communities building mutual trust;in-country and cross-nation preparedness for health, safety, and security emergencies;transparent communication during the evacuation among all involved parties in every nation with Volunteers; andin-country and host country staff support across countries during the evacuation. This case study illustrates elements of effective and sustainable partnerships that ensure their effectiveness during a crisis and survival beyond the crisis. I write this at the anniversary of one year from my stepping down as the twentieth Director of the Peace Corps. During my tenure, I brought home all 7 000 currently serving Volunteers in nine days as the Covid-19 pandemic spread across countries. This massive - and successful - undertaking was possible because of long-standing and trusted partnerships between the Peace Corps and the communities and countries hosting Peace Corps Volunteers. This is my personal reflection and a reminder to build, honor, and tend relationships with international partners who are collaborators in learning, service, and research in good times and our friends, protectors, and allies in times of crisis., Competing Interests: The author has no competing interests to declare., (Copyright: © 2022 The Author(s).)

Summary: Background: Although the 2009–2010 influenza A (H1N1) pandemic was of low severity compared with other pandemics of the 20th century, this pandemic was the first opportunity for countries to implement a real-life pandemic response. The aim of the project was to review the extent to which these plans and planning activities proved useful and to identify areas of pandemic planning that require further strengthening. Methods: We randomly selected seven countries within the WHO European Region to participate in a comprehensive, qualitative study to evaluate the pandemic preparedness activities undertaken prior to March 2009 compared with the subsequent pandemic responses mounted from May 2009 onwards. Research teams visited each country and interviewed stakeholders from health and civil response ministries, national public health authorities, regional authorities and family and hospital doctors. Results: The following six consistent themes were identified as essential elements of successful pandemic preparedness activities: communication, coordination, capacity building, adaptability/flexibility, leadership and mutual support. Regarding future pandemic preparedness activities, an emphasis on these areas should be retained and planning for the following activities should be improved: communication (i.e., with the public and health professionals); coordination of vaccine procurement and logistics; flexibility of response and hospital surveillance. Conclusions: Pandemic preparedness activities were successfully undertaken in the WHO European Region prior to the 2009 pandemic. These activities proved to be effective and were generally appropriate for the response provided in 2009. Nevertheless, consistent themes also emerged regarding specific areas of under planning that were common to most of the surveyed countries. [ABSTRACT FROM AUTHOR]